Thrombophilia and Severe Preeclampsia

Abstract

The term thrombophilia is used to describe a heterogenous group of coagulation abnormalities (acquired or inherited) that are generally associated with increased risk of arterial and venous thrombosis.1 Antiphospholipid antibodies (APA) is the most frequent acquired thrombophilic disorder during pregnancy. It is generally diagnosed in the presence of elevated levels of IgG and IgM (GpL or MpL values ≥20) or the presence of lupus auticoagulant.2 The most common inherited thrombophilic disorders during pregnancy are mutations in factor V Leiden (FVL), prothrombin gene, and tetrahydrofolate reductase. During the past 2 decades, epidemiologic and case-control studies have evaluated the association between thrombophilias and adverse pregnancy outcome (APO), specifically, preeclampsia and intrauterine fetal growth restriction (IUGR).1–5 An association between severe preeclampsia at <34 weeks and APA was first reported by Branch et al in 1989.2 Based on this report, recommendations were made that women with severe preeclampsia at <34 weeks be screened for the presence of APA and be treated if positive in subsequent pregnancies. Since that publication, several studies were published supporting or refuting an association between these antibodies and preeclampsia.6,7 Indeed, a recent report concluded that data do not support routine testing for APA in women with early-onset preeclampsia.6 An association between preeclampsia and inherited thrombophilias was first reported by Dekker et al in 1995.8 Since then, a large number of retrospective and case-controlled studies have examined the association …